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In This Issue of JAMA Ophthalmology
September 2017


JAMA Ophthalmol. 2017;135(9):903. doi:10.1001/jamaophthalmol.2016.3752


Vitreous floaters are common and can worsen visual quality. YAG vitreolysis has been considered to address these symptoms and is an untested treatment for floaters. To evaluate this treatment, Shah and Heier report a randomized clinical trial to determine whether YAG laser vitreolysis is safe and effective for patients with symptomatic vitreous floaters in the context of a posterior vitreous detachment. Among 52 patients randomized to receive YAG laser vitreolysis vs sham laser vitreolysis, the YAG laser group reported greater improvement in symptoms. No clinically relevant adverse events were identified. Although the results suggest that YAG laser vitreolysis can improve visual symptoms associated with symptomatic vitreous floaters, larger studies with longer durations are needed to validate these findings and expand the ability to identify adverse events.

Invited Commentary

Journal Club

Exposure of the tube of an aqueous drainage device through the conjunctiva is a serious complication following placement of the device. Although placement of gamma-irradiated sterile cornea as a patch graft over the tube is common, exposures still occur. de Luna and coauthors investigate whether gamma-irradiated sterile cornea patch grafts become thinner after aqueous drainage device surgery. In a cross-sectional study including 107 patients, thinner grafts were observed as the time after surgery lengthened as assessed by anterior segment optical coherence tomography. The odds ratio per year that the graft was undetectable was 2.1 (95% CI, 1.5-3.0; P < .001). These results indicate that these cornea patch grafts can thin and may become undetectable after surgery, suggesting their placement is no guarantee against exposure. The authors advocate for better materials and strategies for preventing tube exposure.

Recognizing that studies report conflicting associations between preeclampsia and retinopathy of prematurity (ROP), Shulman and coauthors evaluate the association between maternal preeclampsia and ROP in infants. In their cohort study, preeclampsia was associated with a 2.5-fold increased risk of infants developing ROP. In the preterm cohort with very low birth weights, preeclampsia was inversely associated with the development of all ROP. The results suggest the association of a reduced risk of ROP among preterm, very low-birth-weight infants may reflect biases from restricting the cohort to prematurity because prematurity is an outcome of preeclampsia.

Journal Club and CME

Little is known about trends in visual function in childhood and its association with social position. Bountziouka and coauthors evaluate whether the distribution of visual function in childhood has changed over time and whether there are associations with social position. In a longitudinal cohort study, data from 3 UK birth cohorts suggest that social position at birth and during childhood were independently associated with visual function, across the full spectrum from normal acuity to blindness, in a complex pattern that changed over time. Although the data span 1961 through 1986, the findings nevertheless imply that early-life social position contributed to a temporal decline in visual function in childhood, which supports the hypothesis that it contributes to the current known social patterning in visual function in older adults.

Invited Commentary